Birth Support Services Expand as Insurance Coverage Grows Nationwide

Professional birth support providers, known as doulas, are becoming more accessible to families across all income levels as insurance companies and state Medicaid programs increasingly cover their services. Research shows these trained professionals can significantly improve maternal and infant health outcomes, particularly for underserved communities.

MEMPHIS, Tenn. — While Shaquoiya Stewart cradled one of her 6-month-old twins, Shanille Bowens held the other during their regular check-in visit. Between watching the babies gaze at each other, Bowens posed the question she regularly asks the mothers in her care: “Do you think there’s anything you need more support with?”

Bowens works as a doula, offering emotional and physical assistance to families throughout pregnancy, childbirth, and the postpartum period — services that were once considered exclusive to wealthy families who could pay out of pocket. Today, doula services are entering the mainstream healthcare system.

Healthcare providers who were previously hesitant about doulas now recognize how these professionals enhance the work of physicians and nurses. With expanding insurance benefits, families across different economic backgrounds can now access this type of care.

According to the National Health Law Program, over 30 states now provide doula reimbursement through Medicaid programs or are working toward such coverage, representing a significant jump from just 14 states in late 2022. Private insurance companies are following suit, including major provider UnitedHealthcare, which introduced a new doula benefit this year. Families paying privately can expect costs that vary significantly but may reach beyond $2,000.

These policy shifts stem from growing evidence demonstrating that these certified, non-medical specialists can dramatically enhance maternal and infant health outcomes. Healthcare experts believe expanding doula access offers a cost-effective strategy for addressing maternal mortality, which disproportionately affects Black mothers like Stewart at rates exceeding three times those of white women.

“Doulas can benefit everybody,” explained Sierra Hill, who coordinates maternal care access for Minnesota’s health department. “And that’s especially true for our communities that are facing a lot of inequities and health disparities.”

Stewart, who receives Tennessee Medicaid benefits, credits Bowens with guiding her through pregnancy anxiety with her twin boys, managing blood pressure complications during delivery, navigating her cesarean section, and coping with postpartum depression.

“I felt safe. It didn’t feel like I was just by myself,” explained Stewart, a 35-year-old single mother raising four children. “She was like my homegirl.”

Data from a 2006 survey by the Childbirth Connection, now part of the National Partnership for Women & Families, showed only 3% of American women received doula care during labor. Researchers estimate this percentage has increased two to three times since then.

More than twenty years ago, when Bowens was expecting her first of six children, a counselor suggested she work with a doula.

“I’m like, ‘A doula, what is that?'” Bowens remembered.

The positive experience Bowens had with her own doula inspired her to pursue this career path. Beyond answering maternal questions and linking families to community resources, Bowens assists her clients in understanding the healthcare system and speaks up for their needs.

“Oftentimes, we become friends with our clients – lifelong friends. We help connect them with resources in the community,” explained Bowens, who established Naturally Nurtured Birth Services. “We cater to them … so it looks different for each client.”

This personalized support proves particularly valuable for mothers from disadvantaged communities.

Studies comparing two groups of socially disadvantaged mothers revealed that those working with doulas experienced four times fewer low birth weight babies, half the rate of birth complications, and significantly higher breastfeeding initiation rates. Additional research published recently found that Medicaid beneficiaries who used doulas had 47% fewer cesarean sections, 29% fewer preterm deliveries, and attended postpartum appointments 46% more frequently.

The postpartum appointment finding holds special significance, noted April Falconi, a Carelon Research scientist who helped author the recent study. Over half of maternal deaths happen during the postpartum period, often due to infection and severe bleeding.

These positive outcomes prompted Minnesota to pioneer Medicaid doula coverage in 2014. Ten years later, the state enhanced this benefit, permitting Medicaid recipients up to 18 doula sessions without requiring prior approval, more than doubling the previous allowance.

“The return on investment is huge,” Hill emphasized.

While doulas don’t need mandatory licensing, states establish qualification requirements for Medicaid reimbursement, and many practitioners pursue certification through private organizations.

Naturally Nurtured participates in a Memphis pilot program where UnitedHealthcare covers doula services through a Tennessee Medicaid initiative. Members receive these services at no cost.

Meanwhile, UnitedHealthcare commercial plan members with doula benefits receive reimbursement for this care. A growing but still limited number of other private insurance plans also include doula coverage.

“I see doulas becoming more and more integrated and accepted by all within the health care system,” said Dr. Margaret-Mary Wilson, chief medical officer at UnitedHealth Group.

This acceptance now extends to hospital physicians and nurses.

Dana Morrison, who leads Doulas of Duluth in Minnesota, acknowledged there “was definitely” pushback from medical teams when she started a decade ago. This resistance existed nationwide, often arising when doulas advocated for approaches that differed from medical professionals’ preferences. Limited integration meant doulas lacked opportunities to establish trust with doctors and nurses.

Currently, Aspirus St. Luke’s hospital partners with Doulas of Duluth through a grant-funded initiative, offering patients scholarships to hire doulas through the organization.

Mallory Cummings, a nurse who coordinates doula services at Aspirus St. Luke’s, reports that birth team members now welcome and value doulas. “What it really comes down to is everyone’s knowledge of what a doula is,” she explained.

During a recent afternoon visit at the Memphis doula center, Mary Bey relaxed in a comfortable chair, holding her sleeping daughter Ca’Mya. Bowens sat nearby, recording notes on her computer.

Following discussions about nursing and sleep patterns, they addressed how Bey, age 39, has been experiencing frequent crying episodes since delivery.

“What brings it on?” Bowens inquired.

“I’ll be scared and I’ll just be so protective and treat her like she’s just glass,” Bey responded.

Bey carries emotional trauma from a previous loss. Before welcoming her daughter last December, she endured a stillbirth, with Bowens providing support throughout that difficult experience.

“She was there when I had to push him out. She was there after, when I was healing. She came to the house. She brought groceries,” recalled Bey, a single mother of four who connected with Bowens through the same pilot program as Stewart.

When Bey discovered she was pregnant again, she reached out to Bowens with a text: “Hey, can you still be my doula?”

Throughout the pregnancy, Bowens addressed all of Bey’s concerns and helped maintain her calm. She attended Bey’s planned cesarean section and provided support when medical staff monitored Ca’Mya for jaundice and what doctors briefly suspected was a cardiac issue.

When Bey later worried about a possible infection in her cesarean incision, Bowens recommended she seek medical evaluation. The infection was confirmed.

Bey believes she couldn’t have managed either pregnancy as successfully, both physically and emotionally, without her doula’s support.

“She makes you feel like she’s family,” Bey said. “She was a friend — my best friend — a cousin, an auntie, a sister. All of the above.”